Posted by anna on July 31, 2001, at 1:14:50
In reply to Re: Geodon question » anna, posted by SalArmy4me on July 31, 2001, at 0:33:22
> One of the country's noted psychopharmacologists (Peter J. Weiden, MD) own experience prescribing ziprasidone, insomnia and agitation are the most common and problematic side effects, at least when switching outpatients from other antipsychotics to ziprasidone. Often patients can't get to sleep or they do not sleep soundly. They become more alert during the day and need fewer total hours of sleep. Among his patients, insomnia seemed to occur about 50% of the time in outpatients who were switched to a starting dose. It usually happens soon after the switch - within a few days to the first week.
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> He described the insomnia and agitation as quite distressing and seems to increase the overall anxiety level in some patients. He recommended some techniques to manage insomnia from ziprasidone switchover or start:
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> 1. Evaluate for other causes of insomnia, especially caffeine intake. Some cases of ziprasidone-induced insomnia seem to improve once caffeine intake is reduced.
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> 2. Add a benzodiazepine (e.g., lorazepam) for sleep. Patients may need higher doses of lorazepam (e.g., 2-3 mg at bedtime) for the first few weeks. His experience with insomnia from ziprasidone is that it abates in about 3-4 weeks on its own, and the lorazepam can then be tapered and discontinued.
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> 3. Continue to overlap the older antipsychotic for a longer period of time, especially if the prior antipsychotic has a sedative effect for the patient.
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> 4. Give more ziprasidone in the morning and less in the evening. For example, if the daily ziprasidone dose is 80 mg/day, the patient can take 60 mg capsule in the morning and a 20 mg capsule in the evening rather than 40 mg twice a day.
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> 5. Postpone increasing the ziprasidone dose until insomnia resolves.Sal, thanks for the help on this, you are just so great for responding to me, you really make me feel welcome here. Hopefully I will get some rest tonight,I will up my nightly klonopin ;), cause the xanax makes me feel too groggy, and I don't have any lorazepam. Warmest regards,
Anna
poster:anna
thread:72661
URL: http://www.dr-bob.org/babble/20010725/msgs/72677.html